In a study using hypothetical cases, physicians commonly made end-of-life treatment decisions that were not consistent with patient preferences stated in explicit advance directives, according to an article in the July 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to background information in the article, significant concern remains about how well physicians know and follow the treatment preferences of their patients. Decisions are particularly problematic for critically ill and dying patients who lose their capacity to make medical decisions. A variety of factors may influence treatment decisions – including the probability of survival or recovery, and perceived quality of life. While advance directives have been widely promoted as a means to ensure that patients’ treatment preferences are followed, there is limited evidence that they actually accomplish this purpose.
Steven B. Hardin, M.D., and colleagues with the Jerry L. Pettis Memorial Veterans Affairs Medical Center and Loma Linda University School of Medicine, Loma Linda, Calif., devised a survey of six hypothetical cases describing patients with serious or life-threatening illnesses who had lost their decision-making capacity. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. The study participants were all internal medicine faculty and resident physicians from Loma Linda University Medical Center and affiliated hospitals.
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